{"id":639,"date":"2017-05-12T02:16:39","date_gmt":"2017-05-12T07:16:39","guid":{"rendered":"http:\/\/www.bocsci.com\/blog\/?p=639"},"modified":"2017-05-12T02:16:39","modified_gmt":"2017-05-12T07:16:39","slug":"teniposide-sometimes-effective-in-brain-metastases-from-non-small-cell-lung-cancer","status":"publish","type":"post","link":"https:\/\/www.bocsci.com\/blog\/teniposide-sometimes-effective-in-brain-metastases-from-non-small-cell-lung-cancer\/","title":{"rendered":"Teniposide sometimes effective in brain metastases from non-small cell lung cancer"},"content":{"rendered":"

Brain metastasis (BM) is a common complication of\u00a0lung cancer, and is usually associated with a dismal\u00a0outcome within a few weeks or months. Non-small\u00a0cell lung cancer (NSCLC) comprises about 75% of all\u00a0lung cancers. Recent epidemiologic data indicate\u00a0that in the western world adenocarcinoma is replacing\u00a0squamous cell carcinoma as the most frequent type.\u00a0Adenocarcinoma tends to metastasize more often to the\u00a0brain than the other histological types of NSCLC,\u00a0thus being the primary tumor that is most frequently\u00a0responsible for BM in patients with cancer<\/a>.<\/p>\n

Approximately 25% of patients with adenocarcinoma will develop clinical signs of BM during the\u00a0course of disease. Usually BM is a part of systemic\u00a0metastatic disease. In about 20% BM develop prior to\u00a0or a few weeks after the diagnosis of the primary lung\u00a0tumor. Particularly in adenocarcinoma BM may remain\u00a0the only site of active metastatic disease.<\/p>\n

Except from the occasional patient with an accessible solitary BM and absence of active systemic disease who will benefit from surgical resection, the standard treatment of BM from NSCLC consists of\u00a0whole brain radiation therapy (WBRT) usually in combination with steroids. About 75% of the patients will\u00a0show clinical improvement upon institution of steroids\u00a0and RT. This palliation however is shortlasting (median\u00a0of 2 months) and most patients will die with progressive, systemic disease after a median of 3 to 4 months. Those patients with an isolated recurrence in the\u00a0brain suffer from progressive neurological dysfunction\u00a0leading to death. Re-irradiation has not shown any benefit, although radiosurgery may be of benefit in\u00a0exceptional cases.<\/p>\n

Systemic chemotherapy is active against BM from\u00a0small cell lung cancer (SCLC), but is generally considered not effective in BM from NSCLC. In recent\u00a0years it has become apparent that a number of agents,\u00a0including the podophyllotoxins\u00a0etoposide<\/a> and teniposide<\/a>, may exert some activity in NSCLC. Intravenous teniposide at a standard dose of 150 mg\/m2<\/sup>\u00a0<\/sup>is followed by a prolonged cytotoxic concentration\u00a0in brain tumor tissue. With this background we\u00a0have studied the efficacy of intravenous teniposide in\u00a0patients with de novo and recurrent BM from NSCLC.<\/p>\n

This study confirms the grim outlook for patients with\u00a0NSCLC who develop BM. Although patients with the\u00a0most unfavorable prognostic factors (uncontrollable\u00a0extracranial tumor, impending brain herniation, low\u00a0performance status) were excluded from this study,\u00a0the median survival of the 7 patients with newly diagnosed BM was only 13 weeks. Only 2 patients survived\u00a0more than 6 months despite additional WBRT after\u00a0teniposide treatment in 4 of the 7 patients. The clinical improvement observed after steroids and systemic\u00a0chemotherapy in 4 of 7 patients in the present study is\u00a0in agreement with the response of BM from NSCLC\u00a0following steroids and RT.<\/p>\n

On the other hand this study shows that a subgroup\u00a0of patients with NSCLC, may show a relatively favorable response to treatment of BM. In the 6 patients who\u00a0were treated for recurrence of previously treated BM,\u00a0the time to first relapse of BM amounted a median of\u00a07 months. Particularly the cytostatic treatment of these\u00a0relatively late relapsed BM seemed to result in substantial palliation: one patient survived systemic treatment\u00a0of recurrent BM about one and a half year in complete\u00a0neurological remission. However, also stabilization of\u00a0the relapsed tumor mass by chemotherapy after initial steroid-induced clinical improvement, lead to a meaningful palliation, as shown in pt 9.<\/p>\n

 <\/p>\n

Reference:<\/p>\n

Boogerd, W., J. J. Van der Sande, and N. Van Zandwijk. “Teniposide sometimes effective in brain metastases from non-small cell lung cancer.”\u00a0Journal of neuro-oncology<\/i><\/em>\u00a041.3 (1999): 285-289.<\/p>\n","protected":false},"excerpt":{"rendered":"

Brain metastasis (BM) is a common complication of\u00a0lung cancer, and is usually associated with a dismal\u00a0outcome within a few weeks or months. Non-small\u00a0cell lung cancer (NSCLC) comprises about 75% of […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[181],"tags":[425,113,426],"_links":{"self":[{"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/posts\/639"}],"collection":[{"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/comments?post=639"}],"version-history":[{"count":1,"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/posts\/639\/revisions"}],"predecessor-version":[{"id":640,"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/posts\/639\/revisions\/640"}],"wp:attachment":[{"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/media?parent=639"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/categories?post=639"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bocsci.com\/blog\/wp-json\/wp\/v2\/tags?post=639"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}